Efficacy of intralesional triamcinolone injection in the management of benign refractory esophageal strictures
DOI:
https://doi.org/10.18203/2320-6012.ijrms20221980Keywords:
Refractory stricture, Intralesional triamcinolone, Savary Gilliard dilationAbstract
Background: Endoscopic therapy is the mainstay in the treatment of esophageal strictures. Refractory strictures are difficult to treat with patients requiring frequent endoscopic therapy. Intralesional steroid injection combined with SG dilation has been reported to reduce the frequency of endoscopic dilation in such cases.
Methods: Ten patients with benign esophageal strictures (corrosive 4, peptic 2, anastomotic 2, radiation-induced 2) were selected for this study. All of them had refractory esophageal stricture. They were being managed with intermittent endoscopic dilation by using Savary Gilliard dilators. All patients were treated by intralesional injections of triamcinolone acetonide 40 mg in a 4-quadrant fashion after SG dilation and were followed up for a period of 1 years. At each session, SG dilation was done followed by 4 injections (4 quadrants) at the proximal margin of the stricture. The interval between dilations and frequency of dilations were calculated before and after triamcinolone injections. A periodic dilation index (PDI) (number of dilations per month) before and after the triamcinolone injections was calculated.
Results: The PDI decreased significantly from 1.7 before injection to 0.6 after injection. This effect was seen irrespective of the etiology of the stricture involved.
Conclusions: Intralesional triamcinolone therapy is a useful and effective therapy for symptom relief in benign refractory esophageal strictures.
References
Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc. 2010;2(2):61-8.
Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointestinal Endoscopy. 2002;56(6):829-34.
Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62:474-5.
Mendelsohn HJ, Maloney WH. The treatment of benign strictures of the esophagus with cortisone injection. Ann Otol Rhinol Laryngol. 1970;79(5):900-4.
Sanden R, Poesl H. Treatment of non-neoplastic stenosis with the neodymium-YAG laser-indications and limitations. Endoscopy. 1986;18:53-6.
Fry SW, Fleischer DE. Management of a refractory benign esophageal stricture with a new biodegradable stent. Gastrointest Endosc. 1997;45:179-82.
Nijhawan S, Udawat HP, Nagar P. Aggressive bougie dilation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus. 2017;30:1-5.
Orive-Calzada A, Bernal-Martinez A, Navajas-Laboa M, Torres-Burgos S, Aguirresarobe M, Lorenzo-Morote M et al. Efficacy of intralesional corticosteroid injection in endoscopic treatment of esophageal strictures. Surg Laparosc Endosc Percutan Tech. 2012;22(6):518-22.
Pereira-Lima JC, Lemos Bonotto M, Hahn GD. A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures. Surg Endosc. 2015;29:1156-60.
Zhang YW, Wei FX, Qi XP, Liu Z, Xu XD, Zhang YC. Efficacy and Safety of Endoscopic Intralesional Triamcinolone Injection for Benign Esophageal Strictures. Gastroenterol Res Pract. 2018;6;2018:7619298.
Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc. 1999;49(4-1):509-13.
Ismail N, Mansour S, Hussien H. The Efficacy of Intralesional Steroid Injection in The Treatment of Corrosive Esophageal Strictures in Children. Zagazig University Med J. 2021;(48-57).
Ahn Y, Coomarasamy C, Ogra R. Efficacy of intralesional triamcinolone injections for benign refractory oesophageal strictures at Counties Manukau Health, New Zealand. NZ Med J. 2015;128:44-50.
Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol. 2017;11(1):53-64.
